Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials
2 Hôpital Raymond Poincaré (Garches) [GHU AP-HP Université Paris-Saclay]
3 Jena University Hospital [Jena]
4 Leipzig University / Universität Leipzig
5 UPD7 - Université Paris Diderot - Paris 7
6 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
7 CHU Pitié-Salpêtrière [AP-HP]
8 SU - Sorbonne Université
9 HUPNVS - Groupe Hospitalier des Hôpitaux Universitaires Paris Nord Val de Seine [Paris]
10 University Hospital Basel [Basel]
11 MHH - Medizinische Hochschule Hannover = Hannover Medical School
12 UCPH - University of Copenhagen = Københavns Universitet
13 VU University Medical Center [Amsterdam]
14 University of Groningen [Groningen]
15 UMCU - University Medical Center [Utrecht]
16 ETZ - St. Elisabeth-TweeSteden Hospital
17 MST - Medisch Spectrum Twente
18 Hospital Israelita Albert Einstein [São Paulo, Brazil]
19 Aarhus University Hospital
20 CHU-Liège - Centre Hospitalier Universitaire de Liège
21 UFMG - Universidade Federal de Minas Gerais = Federal University of Minas Gerais [Belo Horizonte, Brazil]
22 Fudan University [Shanghai]
23 Monash University [Melbourne]
24 UNIMORE - Università degli Studi di Modena e Reggio Emilia = University of Modena and Reggio Emilia
25 CUMS - Capital University of Medical Sciences [Beijing]
26 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
27 TIMC-GREPI - Groupe de Recherche et d’Étude du Processus Inflammatoire
- Fonction : Auteur
- PersonId : 761134
- ORCID : 0000-0001-6805-8944
- IdRef : 070300917
- Fonction : Auteur
- Fonction : Auteur
Résumé
Abstract Background Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients. Objective and design We performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome. Subjects and methods We had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (<75 years [n = 7,079], 75–80 years [n = 1,034], 81–85 years [n = 803] and >85 years [n = 505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay. Results Compared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of −1.99 (95% confidence interval [CI] −2.36 to −1.62), −1.98 (95% CI −2.94 to −1.02), −2.20 (95% CI −3.15 to −1.25) and − 2.10 (95% CI −3.29 to −0.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction >0.05). Conclusions This large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality.